Wk 4: Managing Stress CH 13

• A generic term for interventions designed to teach participants how to cope with stress.
• Most focus on changing people's reactions to events.
• Eg relaxation technique or change participants' cognitive reactions.

• Triggers can be identified and modified using problem solving strategies.
• Cognitive distortions can be identified and changed through cognitive techniques such as cognitive restructuring.
• High levels of muscular tension and other signs of high arousal can be reduced through relaxation techniques.
• 'Stressed' behaviour can be changed through consideration and rehearsal of alternative behavioural responses.

Set of unconscious beliefs about the world and ourselves that shape more conscious cognitive responses to events that impinge on us

• Referred to thought that drive negative emotions as automatic negative assumptions.
• Come to mind automatically as the individual's first response to a particular situation and are without logic or grounding in reality. 
• Two levels of cognition:
• Surface cognitions: ones we are aware of; can access and report them relatively easily. Cognitive schema infuence these.

• Catastrophic thinking: considering an event as completely negative, and potentially disastrous.
• Over-generalisation: drawing a general (negative) conclusion on the basis of a single incident eg. thats it- pain stopped me from going to the cinema- thats something else i can't do.
• Arbitrary inference: drawing a conclusion without sufficient evidence to support it eg. the pain means i have a tumour, i know it.
• Selective abstraction: focusing on a detail taken out of context (ok, i know I was able to cope with going out, but my joints ached all the time, and I know that will stop me going out in the future".

• Assumes stress lies within the individual.
• Ariises from the minsinterpretation of events that happen to us.

A reconsideration of automatic negative or catastrophic thoughts to make them more in line with reality.

Identify and  change their nature or reduce frequency with which they occur.

• Practice first in comfortable situations.
• Most commonly taught; Jacobson's deep muscle relaxation technique. 
• Involves alternately tensing and relaxing muscle groups throughout the body in an ordered sequence. 
• Monitor levels of physical tension throughout the day, to identify triggers. Tension diary.

• 2 strategies frequently employed
• 1. elf instruction training- targeted at surface cognitions. 
• Involves interrupting flow of stress provoking thoughts and replacing them with pre-rehearsed stress reducing or coping thoughts. 
• Called positive self-talk

2. cognitive restructuring: involves first identifying and then challenging the accuracy of stress provoking thoughts. Assess validity without bias. 

Meditation: a state of concentrated attention on some object of thought or awareness.

• Goal is to help individual respond to any stress triggers in way that will maximise effectiveness of dealing with them and cause minimal stress. 
• Teach individual to plan their response to potential stressors.

• Meichembaum
• A form of stress reducing intervention in which participants are taught to control stress by rehearsing prior to going into stressful situations.
• Combination of previously mentioned things.
• Participants taught to relax, use calming self talk.

Simplest way to minimise stress to teach stress management techniques.

• Workplace classes have been found to reduce stress.
• However does not capture everyone- some avoid because don't want to show they're stressed.
• Also places too much importance on coping rather than the cause. 
• Can use organisational intervention: identifying causes stress, solutions and addressing issue.

• Disorder that forms a response to experiencing a traumatic event. 
• Key elements are unwanted repetitive memories of the event (eg flashbacks), attempts to avoid memories and generally raised level of arousal.

• Psychological debriefing: procedure in which people who have been through a particular trauma talk through the trauma in a structured way with a counsellor. This may encourage the memories to be integrated into general memory and not be isolated and emotionally distressing. 
• Effectivity is questionable. 
• May actually increase risk of PTSD through:
• 'Secondary traumatisation': further exposure to event within short period of time.
• May 'medicalise' normal distress and increase expectancy of developing psychological symptoms who otherwise would not have done so.
• May prevent potentially protective responses such as denial and distancing.

• Exposure therapy: a form of therapy involving exposure to traumatic memories, based on the theoretical assumption that continued exposure will result in a gradual reduction in the level of fear associated with such memories.
• Mixed with relaxation techniques, cognitive restructuring

• Eye movement desensitisation and reprocessing (EMDR): a form of therapy for PTSD involving exposure to traumatic memories while repeatedly moving the eyes.
• Its method of working is not clear.
• Most popular theory is that when eyes move back and forth, creates brain activity similar to REM sleep.
• This may help the brain to process the 'stuck' material, enabling the person to arrive at an adaptive resolution. 
• Effective however not significant compared to other treatments.

• We feel less anxiety if we can be given some degree of control over the situation. 
• Cannot do this much in hospital setting so can be interpreted as "keeping people informed about what is happening to them".
• Reduce anxiety by minimising fear of unknown. 
• Procedural info (events of procedure) and sensory info (what they will feel before and after)

• Match intervention to characteristics.
• Eg. avoidant coping person may benefit from receiving less info. 
• POssible that anxious patients may benefit most when they are given relatively little info but info given matches needs.
• Teaching relaxation mixed results. 
• Those with relatively low levels of anxiety seemed to benefit most from relaxation techniques. 
• Those with high, did not benefit. Maybe anxiety prevented them from learning and implementing well.

• Participants in procedural intervention reported less anxiety, less anaesthetic and lower heart rates. 
• Exposure beforehand to the setting, procedure lowers stress. Eg. video
• Also interventions targeting parents.
• More complex such as cognitive restructuring also effective however takes time.